J Am Med Inform Assoc 13:619-626 doi:10.1197/jamia.M2103
  • The Practice of Informatics
  • Technical Brief

Use and Perceived Benefits of Handheld Computer-based Clinical References

  1. Jeffrey M Rothschild,
  2. Edward Fang,
  3. Vincent Liu,
  4. Irina Litvak,
  5. Cathy Yoon,
  6. David W Bates
  1. Affiliations of the authors: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA (JMR, CY, DWB), Department of Medicine, Harvard Medical School, Boston, MA (JMR, DWB), Epocrates Inc, San Mateo, CA (EF, VL); Partners Healthcare System, Wellesley, MA (IL, DWB)
  1. Correspondence and Reprints: Jeffrey M. Rothschild, MD, MPH, Division of General Medicine, Brigham and Women’s Hospital, 1620 Tremont Street, Boston, MA 02120-1613; e-mail: jrothschild{at}
  • Received 14 March 2006
  • Accepted 11 July 2006


Objective Clinicians are increasingly using handheld computers (HC) during patient care. We sought to assess the role of HC-based clinical reference software in medical practice by conducting a survey and assessing actual usage behavior.

Design During a 2-week period in February 2005, 3600 users of a HC-based clinical reference application were asked by e-mail to complete a survey and permit analysis of their usage patterns. The software includes a pharmacopeia, an infectious disease reference, a medical diagnostic and therapeutic reference and transmits medical alerts and other notifications during HC synchronizations. Software usage data were captured during HC synchronization for the 4 weeks prior to survey completion.

Measurements Survey responses and software usage data.

Results The survey response rate was 42% (n = 1501). Physicians reported using the clinical reference software for a mean of 4 years and 39% reported using the software during more than half of patient encounters. Physicians who synchronized their HC during the data collection period (n = 1249; 83%) used the pharmacopeia for unique drug lookups a mean of 6.3 times per day (SD 12.4). The majority of users (61%) believed that in the prior 4 weeks, use of the clinical reference prevented adverse drug events or medication errors 3 or more times. Physicians also believed that alerts and other notifications improved patient care if they were public health warnings (e.g. about influenza), new immunization guidelines or drug alert warnings (e.g. rofecoxib withdrawal).

Conclusion Current adopters of HC-based medical references use these tools frequently, and found them to improve patient care and be valuable in learning of recent alerts and warnings.


  • This study was funded by a grant from Epocrates, Inc in San Mateo, CA.

    Role of the Sponsor: Design and conduct of the study: The sponsor approved the study design submitted by Drs. Rothschild and Bates for the grant support. Collection, management, analysis and interpretation of the data: The sponsor was responsible for electronically distributing the survey and collecting both survey and synchronized usage tracking data. The sponsor deidentified survey responses and tracking data prior to sending them to the other authors for analysis. The sponsor participated in the data analysis. Drs. Rothschild and Bates were responsible for the final interpretation of the data. Preparation, review, or approval of the manuscript: The sponsor reviewed and approved the manuscript. Dr. Rothschild was responsible for final decisions regarding the manuscript’s content.

    Dr. Jeffrey Rothschild, the Principal Investigator, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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